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Kidney Week

ASN / Education & Meetings / Kidney Week /

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Abstract: PO0847

Quality of Life and Symptom Burden Before and After Start of Dialysis in Older Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • de Rooij, Esther N.m., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
  • Meuleman, Yvette, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
  • De Fijter, Johan W., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
  • Jager, Kitty J., Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
  • Chesnaye, Nicholas C., Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
  • Wanner, Christoph, Universitatsklinikum Wurzburg, Wurzburg, Bayern, Germany
  • Dekker, Friedo W., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
  • Hoogeveen, Ellen K., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands

Group or Team Name

  • the EQUAL Study investigators
Background

The number of ESKD patients ≥65y starting chronic dialysis increases. Many of these patients have low quality of life (QoL) and high symptom burden. Little is known about the effect of dialysis initiation on QoL and symptoms. Therefore, we studied QoL and symptoms before and after start of dialysis in older patients.

Methods

The European Quality (EQUAL) study is an ongoing prospective multi-center cohort study in late stage 4/5 CKD patients ≥65 years. For this analysis, we included all patients who started dialysis. QoL was assessed every 3-6 months using the SF-36, resulting in a physical (PCS) and mental (MCS) component score, with higher scores meaning better QoL. Symptom number and severity were assessed every 3-6 months using the dialysis symptom index (DSI), with higher scores meaning higher burden. With linear mixed models we explored the evolution of mental and physical QoL, symptom number and severity in the year before and after dialysis start.

Results

We included 571 older patients at dialysis start. Mean (SD) age was 77 (6) years, 74% were men, 45% had diabetes or cardiovascular disease and mean eGFR was 8.2 (3.7) ml/min/1.73m2. In the year before dialysis MCS decreased by -15.7 (95% CI: -19.5 to -11.8), PCS by -12.0 (-15.7 to -8.2), symptom number increased by +3.5 (+2.5 to +4.6) and severity by +14.8 (+10.9 to +18.8). In the year after, MCS increased by +1.9 (-2.7 to +6.4), PCS decreased by -2.1 (-6.9 to +2.7), symptom number by -0.9 (-2.1 to -0.3) and severity by -6.0 (-10.4 to -1.7).

Conclusion

Mental and physical QoL, symptom number and severity, worsened considerably in the year before dialysis, but stabilized after dialysis initiation. These results could inform older ESKD patients who consider starting dialysis.